ABSTRACT: In November 2006, we made two new additions to our animal collection at the West Midland Safari Park. Two 15-month-old cheetah brothers were to become the Park's main animal attraction on the newly developed 'Cheetah Plains'. This exhibit was part of our ongoing collection plan and they were to be joined by more cheetahs in the foreseeable future.

Our park has a ‘Balai-approved’ status, which means that we actively remain disease free by following strict protocols of quarantine and disease surveillance. Because of this status, our cheetahs were to remain in quarantine for one month before allowing them to explore their new facility. Both settled into their new surroundings well and were housed and fed together. The only veterinary intervention I anticipated was the collection of faecal samples every three months for routine parasitology checks.

As the only veterinary nurse at the Safari Park, I have a good working relationship with our keeping staff. As they see their animals every day, any physical abnormalities and behavioural changes are easily identified and reported back to me.

First signs of trouble

In February 2008, the keepers had noticed that one of the males, ‘Bulika’, was starting to lose condition and looking depressed, so I called in our vet. After a visual examination, a course of clavulanate-potentiated amoxicillin (Synulox Bolus 500mg – Pfizer) was prescribed and two tablets were administered twice daily crushed in his food, for five days.

I checked him daily during this course of treatment, but we did not see any changes in his demeanour, so the antibiotic therapy was extended for a further week. After Day 12, we started to see a small improvement in his condition. He seemed brighter, so he was let out on to the ‘Cheetah Plains’ for the first time.

We continued to observe him daily for any changes in his behaviour and condition. Four days into the extended antibiotic course, we noticed that he had begun to lick around his genitalia for excessive periods of time. Despite this persistent grooming, there was nothing obvious to be seen as he remained bright and seemed to be improving.

On the 21st February, 16 days after the first clinical signs had been seen, he had become incontinent with clear evidence, from his hindquarters, of polyuria. He was also very lethargic. With the onset of these symptoms, the vet decided on sedation to investigate further.

Examination under sedation

The patient’s weight was estimated at 40kg and we used a combination of 2.2ml medatomidine (Domitor – Janssen) and 2.2ml ketamine (Ketaset – Pfizer). I administered this via our Dan inject dart rifle in two separate 3ml darts. The sedation took 15 minutes to take effect and he was then switched to maintenance on oxygen throughout the procedure, with a pulse oximeter applied to his tongue to monitor heart rate and oxygen saturation.

The vet gave him a thorough physical examination. All felt normal with the exception of an abnormal palpable mass in the abdomen. An ultrasound confirmed the mass but all other structures looked normal. We took lateral and dorsal ventral abdominal radiographs and the X-rays did not reveal anything different (Figures 1-3).

Figure 1: Preparing 'Bulika' for the ultrasound and radiographs

Figure 2: Monitoring and preparing for radiographs

Figure 3:. Positioning ‘Bulika’ for lateral abdominal radiographs

Sedation was reversed using 2.2ml atipamezole (Antisedan – Janssen) injected intramuscularly and he was left to recover in a separate pen in isolation. The bloods taken during the procedure were sent for analysis and showed a high white blood cell count which indicated an infection.

Tricky dilemma

This clinical picture posed an awkward ethical dilemma – one in which I had not previously been involved. The prognosis for investigative abdominal surgery or treatment is not always good in exotics. Surgery itself is often relatively straightforward, but the postoperative care is usually where the problems occur.

Additionally, if an operation either didn’t succeed, or the condition proved inoperable, we would be left with one of a closely bonded pair of cheetahs pining in isolation. We were expecting our new cheetah to arrive from South Africa, so the question put to our ethical committee, comprising park directors and vets, was, “Do we treat and delay the operation until our new cheetah arrives?”. The answer to this was “Yes”.

Accordingly he was given a further antibiotic course with the view that once stronger, we would operate. He was placed on clindamycin hydrochloride (Antirobe 450mg, – Pfizer) UID for the next four weeks.

The antibiotic seemed to be working well and over the next two months the incontinence had ceased and he was much livelier. He was under constant observation and had regular vet checks. Apart from occasional relapses, he was back to normal and gaining weight. To combat these setbacks, the antibiotic was changed to amoxicillin trihydrate (Noroclav 250mg – Norbrook) at the rate of two tablets UID for three weeks. This was administered orally in his food as, fortunately, his appetite remained consistent throughout.

Circumstances precipitated action

Two months later, in July, the clinical symptoms appeared again. ‘Bulika’ became incontinent, with polyuria and diarrhoea, and he started to lose condition. He was given another course of antibiotic, marbofloxacin (Marbocyl P 80mg – Vetoquinol) one tablet UID for five days and metronidazole (Metronidazole 200mg – Pharmvit) two tablets UID for five days. Fortunately the new arrivals were imminent.

However, this too posed logistical problems; for once they arrived the entire cheetah house would become a rabies isolation unit making an operation difficult. Once we were sure the newcomers were actually on the plane in South Africa, we proceeded with the operation.

The patient was sedated with 2.2ml medatomidine (Domitor – Janssen) and 2.2ml ketamine (Ketaset – Pfizer). Within 15 minutes, I was off on the short trip to the Park’s veterinary surgery where he was maintained under general anaesthetic using isoflurane gas, and prepared for surgery.

An exploratory laparotomy was performed. No one really knew what to expect, or what would be found. And we were definitely all in for a huge surprise! The vet removed approximately 1.8kg of wooden shavings – the bedding being used in the cheetahs’ house. This was a surprise as nothing abnormal had been identified in his faeces (Figures 4-6).

Figure 4: Preparing 'BuLika' for the ultrasound and radiographs

Figure 5: The incision into the stomach showing the wood shavings

Figure 6: The total amount of shavings removed weighed 1.8kg

Once all the foreign material had been removed, sodium benzyl penicillin (Crystapen – Intervet/Schering-Plough) reconstituted with 20ml sterile water was administered into the abdominal cavity and the would was closed up using intradermal dissolvable Vicryl sutures (Figure 7). ‘Bulika’ was revived with 2.2ml atipamezole (Antisedan – Janssen) and returned to the park to recover … just as the new cheetah arrived!

Figure 7: Closing up the wound after exploratory surgery

Post-operative care was very simple in this case as the sutures were intradermal and dissolvable, so no further sedation was necessary for removal. He recovered overnight and within two days regained his appetite and was reunited with his brother. There was minimal interference with the wound area and I checked him on a daily basis.

An urgent review of bedding usage in the carnivore houses was undertaken. The cheetahs were fed a two kilo piece of meat in their pens at night in a clear feeding area. Observation showed they would take the piece of meat from the feeding area and drag it to different places around the pen, subsequently dropping it into their bedding. As the meat was licked the attached shavings were ingested by the cheetah.

We have never had any problems with this before, but since then problems have arisen with both lion cubs and wolves. Consequently we have stopped using all wood shavings and replaced them with straw. We have had no further concerns with ‘Bulika’ or anyone else.

This case was a particularly uplifting one as I and all the staff had feared the worst when a mass was palpated. We found we were counting the days to surgery and were apprehensive as to what would be found. It is always difficult when working with such species as they are not ‘hands on’ like a domestic animal and as a result you are very restricted and hugely reliant on your own observations and that of others.

We are all pleased with the prognosis for ‘Bulika’. Since the surgery, he has thrived, gained weight and is now part of the biggest cheetah group in the UK.

Acknowledgements

I would like to express thanks to all that were involved with 'Bulika' at the Vale Veterinary Group, Stourport-on-Severn.

Author

Lucy Ireland RVN MBVNA

Lucy Ireland qualified as a Veterinary Nurse whilst working in mixed practice in Worcestershire. Since then, she has studied for the City & Guilds Certificate in Exotic Species and is the BVNA regional co-ordinator (RCO) for the Midlands.

Lucy is currently the senior veterinary nurse at West Midlands Safari Park, where she loves the everyday challenges that working with zoo exotics brings.

• VOL 25 • No8 • August 2010 • Veterinary Nursing Journal